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We appear to be heading toward a crisis over the president’s expected action on immigration. Luckily, the recent showdown over Obamacare provides ample lessons on how to react. (John Feehery, 11/19)

A suggested bit of homework for the new GOP Congress: Reread “Romeo and Juliet.” Not for the lovey-dovey bits – a GOP-Dem mutual suicide pact is probably a likelier scenario – but there’s one line the Republicans should keep in mind before trying to pull down Obamacare as if it were a Saddam Hussein statue: Juliet: “’Tis but thy name that is my enemy.” Take away the name and what is Obamacare, but a checklist of solid GOP values? (Patt Morrison, 11/19)

When the Supreme Court narrowly upheld the individual health insurance mandate in National Federation of Independent Business v Sebelius (2012), the future of the Affordable Care Act (ACA) appeared secure. However, the case opened the door to 22 states refusing to expand Medicaid coverage for the poor—a major setback for health equity. In addition, 19 states opted for fully federally operated exchanges (marketplaces to purchase insurance), and another 15 for a hybrid system, with the federal government retaining ownership. When states decided not to form state-run exchanges, few experts expected adverse consequences. But all that could change. (Lawrence Gostin, 11/19)

The Supreme Court is expected to rule next year on King v. Burwell, the lawsuit in which the federal government’s authority to provide financial assistance to people who buy insurance in federally operated insurance exchanges is being challenged under a strict reading of the Affordable Care Act. Thirty-seven states have federal exchanges. ... a decision for the plaintiffs would deny financial assistance for insurance premiums to approximately 13 million Americans in 2016. More than half are in a few big anti-ACA states that chose not to run their own exchanges: Florida, Texas, North Carolina, Georgia, and Pennsylvania. But the consequences in other states are not small: In total, 100,000 to 500,000 people in 22 other states would become ineligible for financial assistance. (Drew Altman, 11/19)

Before the U.S. political system goes to the mattresses, I’d like to spend a moment discussing Jonathan Gruber, ObamaCare and the American people. Jon Gruber is the now-famous ObamaCare designer and explainer-for-hire who said the Affordable Care Act became law because the American people were too stupid to understand what was in it. ... Jon Gruber’s remarks matter not for what they say about the Democratic Party’s modus operandi but because of the truths he revealed about the Democratic Party’s reason for being. The Gruber threat to the Democrats isn’t reputational; it’s existential. The Democrats have believed for decades that if they build it—a health-care entitlement or any other federal bestowment—the voters will come. That political model is cracking. (Daniel Henninger, 11/19)

I could try to convince conservatives that the problem is not actually with Gruber, who's basically a smart and, yes, well-meaning guy, for all that we vehemently disagree. The problem is not even really with the Barack Obama administration. The problem is with the system and the way that elites in that system treat others. I could tell them that "conspiracy" is far too strong a word for something that both sides do every time they get the chance. ... What is not inevitable is that journalists should effectively sanction this by saying it's no big deal. ... We shouldn't act like we're part of the insider clique that decides what other people need to know -- no, worse, that decides what other people do know. If we knew this all along and voters didn't, that doesn't mean voters don't have a right to be outraged. It means that we've lost track of whose side we're on. (Megan McArdle, 11/19)

To date, Missouri has failed to expand its Medicaid program as part of the Affordable Care Act, aka "Obamacare." As a result, federal dollars that would normally flow to underserved areas are being transferred to states that have expanded their programs. This loss of funding has major implications for health care in our state especially for those in areas of poverty and who are underserved. One particularly susceptible area is rural Missouri. (Terry Weiss, 11/19)

One of the loudest complaints about the policies sold through Covered California, the state's new health insurance exchange, is that they provide access to far fewer doctors than promised. On Wednesday, state regulators finally confirmed and quantified the problem with respect to two leading insurers, Anthem Blue Cross and Blue Shield of California. Yet as is typical in the healthcare industry, it's not entirely clear who's responsible, nor is there an easy fix. (11/19)

Some 39 percent of adults serve as full- or part-time caregivers to a loved one struggling with a disease or disability. You almost certainly know one of them. But do you know what kind of strain they are under? And are you making any effort to support them? In caregiver support groups, I hear the same question again and again: What has happened to all of my friends? Where are they now, when I need them most? (Mary McDaniel Cail, 11/19)

More than half of patients believe they own their records, and nearly 40 percent of physicians think they own their patients' records. Well, these doctors (and hospitals) are right—they legally own the records. But should they? With all of the remarkable issues surrounding a patient's access to her own records, including multiple providers, cost, and inconvenience, isn't it high time for rightful ownership to belong to the consumer? After all, the patient paid for the visit, procedure, lab test, scan, or hospitalization. It's his or her body. For centuries, the medical community believed that patients could not handle seeing their own information for fear that it would induce major anxiety. They also believed that the information wouldn't be understood; medical jargon is much too complicated for a layperson. (Dr. Eric Topol, 11/18)

The principle of data sharing dates to the dawn of scientific discovery — it is how researchers from different disciplines and countries form collaborations, learn from others, identify new scientific opportunities, and work to turn newly discovered information into shared knowledge and practical advances. When research involves human volunteers who agree to participate in clinical trials ..., this principle of data sharing properly assumes the role of an ethical mandate. These participants are often informed that such research might not benefit them directly, but may affect the lives of others. If the clinical research community fails to share what is learned, allowing data to remain unpublished or unreported, researchers are reneging on the promise ... and are jeopardizing public trust. (Kathy L. Hudson and Francis S. Collins, 11/19)

On May 6, 2013, I was arrested by the North Carolina Capitol Police in front of the doors of the state Senate chamber, protesting our legislature's decision to forgo Medicaid expansion under the Affordable Care Act (ACA). For a practicing physician and professor of medicine, this was an unusual turn of events in an academic career. But given that 23 states have decided not to expand Medicaid, I find it less surprising that I was arrested than that more health care professionals have not taken to the streets to protest the harm being wreaked on our patients by decisions driven by partisan politics. (Dr. Charles van der Horst, 11/20)

[C]ommunicating uncertainty often undermines perceived expertise, but if you don't communicate uncertainty and end up being wrong, you risk losing even more credibility. Management of the Ebola “crisis” in the United States has crystallized this dilemma. ... Containing the epidemic requires continued efforts by dedicated international health workers and a willingness to trust that though our health authorities cannot know everything, they will do everything they can to protect us with the knowledge they have. (Dr. Lisa Rosenbaum, 11/20)

Several provisions of the Affordable Care Act (ACA) are designed to address the long-standing gap in [tobacco] cessation coverage and thereby increase rates of cessation. Though these provisions have received little publicity, they could contribute greatly to improving the quality of health care and achieving better health outcomes while reducing health care costs. (Dr. Tim McAfee, Stephen Babb, Simon McNabb and Dr. Michael C. Fiore, 11/19)